Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study
- PMID: 37435985
- DOI: 10.1111/aos.15733
Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study
Abstract
Purpose: To assess the safety and efficacy of combining phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT) compared to phacoemulsification alone in the management of primary angle closure glaucoma (PACG).
Methods: Prospective, institutional study in which eyes requiring surgery for PACG were randomized to undergo phacoemulsification followed by GATT (phaco-GATT group) or phacoemulsification alone. Success was defined as having a final IOP of 6-20 mmHg with no subsequent glaucoma surgery or vision-threatening complications.
Results: Thirty-six eyes underwent phaco-GATT with 360° angle incision and 38 eyes underwent phacoemulsification alone. IOP and glaucoma medications were significantly lower in the phaco-GATT group at 1, 3, 6, 9 and 12 months. The success rate in the phaco-GATT group was 94.4% after 12.16 ± 2.03 months, with 75% of eyes being off medications compared to 86.8% after 12.47 ± 4.27 months in the phaco group, with 42.1% off medications. (p = 0.008). Hyphema and fibrinous anterior chamber reaction were the most common complications in the phaco-GATT group and resolved with conservative treatment or required YAG capsulotomy. Although this delayed visual rehabilitation in the phaco-GATT group, it did not affect the final visual outcome with no significant difference in the final best-corrected visual acuity between both groups (p = 0.25).
Conclusion: Combining phacoemulsification with GATT in PACG yielded more favourable outcomes in terms of IOP, glaucoma medications and surgical success. Although the postoperative hyphema and fibrinous reaction may delay visual rehabilitation, GATT further lowers the IOP by breaking residual peripheral anterior synechiae and removing the dysfunctional trabeculum circumferentially, while avoiding the risks inherent in more invasive filtering procedures.
Keywords: angle closure glaucoma; angle surgery; gonioscopy-assisted transluminal trabeculotomy; phacoemulsification; trabeculotomy.
© 2023 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Similar articles
-
Optimizing the sequential approach of combined phacoemulsification and gonioscopy-assisted transluminal trabeculotomy (GATT) in primary open-angle glaucoma.BMC Ophthalmol. 2025 Apr 28;25(1):256. doi: 10.1186/s12886-025-04097-6. BMC Ophthalmol. 2025. PMID: 40296008 Free PMC article.
-
Early outcomes of 5-0 Prolene gonioscopy-assisted transluminal trabeculotomy combined with phacoemulsification in eyes of Indian glaucoma patients.Indian J Ophthalmol. 2025 Mar 1;73(Suppl 2):S287-S292. doi: 10.4103/IJO.IJO_3065_23. Epub 2024 Aug 14. Indian J Ophthalmol. 2025. PMID: 39141485 Free PMC article.
-
Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject.Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):3035-3044. doi: 10.1007/s00417-021-05133-z. Epub 2021 May 20. Graefes Arch Clin Exp Ophthalmol. 2021. PMID: 34014384
-
Lens extraction for chronic angle-closure glaucoma.Cochrane Database Syst Rev. 2021 Mar 24;3(3):CD005555. doi: 10.1002/14651858.CD005555.pub3. Cochrane Database Syst Rev. 2021. PMID: 33759192 Free PMC article.
-
Combined Microinvasive Glaucoma Surgery With Phacoemulsification in Open-Angle Glaucoma: A Systematic Review and Meta-analysis.Am J Ophthalmol. 2025 Feb;270:154-163. doi: 10.1016/j.ajo.2024.07.034. Epub 2024 Jul 31. Am J Ophthalmol. 2025. PMID: 39089358
Cited by
-
Lens Thickness-to-Anterior Chamber Depth Ratio: A Biometric Determinant of Chamber Angle Width in Han Chinese Cataract Patients.Invest Ophthalmol Vis Sci. 2025 Mar 3;66(3):42. doi: 10.1167/iovs.66.3.42. Invest Ophthalmol Vis Sci. 2025. PMID: 40111355 Free PMC article.
-
Two-Year Outcomes of Phacogoniotomy vs Phacotrabeculectomy for Advanced Primary Angle-Closure Glaucoma With Cataract: A Noninferiority Randomized Clinical Trial.JAMA Ophthalmol. 2025 Jun 1;143(6):462-469. doi: 10.1001/jamaophthalmol.2025.0685. JAMA Ophthalmol. 2025. PMID: 40244620 Clinical Trial.
-
Phacoemulsification combined with trabecular meshwork-Schlemm canal-based minimally invasive glaucoma surgery in primary angle-closure glaucoma: a systematic review and meta-analysis.BMC Ophthalmol. 2025 Apr 3;25(1):168. doi: 10.1186/s12886-025-04005-y. BMC Ophthalmol. 2025. PMID: 40181304 Free PMC article.
-
Analysis of surgical outcomes and risk factors after gonioscopy-assisted transluminal trabeculotomy.BMC Ophthalmol. 2025 Jul 23;25(1):423. doi: 10.1186/s12886-025-04242-1. BMC Ophthalmol. 2025. PMID: 40702420 Free PMC article.
-
Revolution in glaucoma treatment: a review elucidating canaloplasty and gonioscopy-assisted transluminal trabeculotomy as modern surgical alternatives.Front Med (Lausanne). 2025 Mar 26;12:1494391. doi: 10.3389/fmed.2025.1494391. eCollection 2025. Front Med (Lausanne). 2025. PMID: 40206463 Free PMC article. Review.
References
REFERENCES
-
- Acton, J., Salmon, J.F. & Scholtz, R. (1997) Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma. Journal of Cataract and Refractive Surgery, 23, 930-934.
-
- Artes, P.H., Nicolela, M.T., LeBlanc, R.P. & Chauhan, B.C. (2005) Visual field progression in glaucoma: total versus pattern deviation analyses. Investigative Opthalmology and Visual Science, 46, 4600-4606.
-
- Azuara-Blanco, A., Burr, J., Ramsay, C., Cooper, D., Foster, P.J., Friedman, D.S. et al. (2016) Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (eagle): a randomised controlled trial. The Lancet, 388, 1389-1397.
-
- Bourne, R.R., Flaxman, S.R., Braithwaite, T., Cicinelli, M.V., Das, A., Jonas, J.B. et al. (2017) Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. The Lancet Global Health, 5, e888-e889.
-
- Chen, P.P., Lin, S.C., Junk, A.K., Radhakrishnan, S., Singh, K. & Chen, T.C. (2015) The effect of phacoemulsification on intraocular pressure in glaucoma patients. Ophthalmology, 122, 1294-1307.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources